Medical Evaluation Form

Cornell University's Animal Users Health and Safety Program (AUHSP) covers all persons having direct or indirect contact with animals for the purpose of evaluating the human-health risks associated with that contact. A risk assessment is conducted for all individuals to ensure that health risks are managed to an acceptable level. For many, a crucial part of the risk assessment involves completing an annual Medical Evaluation Form (MEF).

In order to protect the health and safety of individuals working with research animals, the AUHSP requires that those involved in the medical surveillance program, and any person named to moderate or high risk protocols or identified as having a medical condition that may affect their personal risk level, complete the MEF. Failure to submit a required MEF will impact an individual's ability to access Cornell's animal care facilities.

Instructions

For online MEF (for faculty, staff, and students with a Cornell Net ID)

The online MEF can be completed via our secure website, myGannett.* We will notify you by email when your form is available. Follow the instructions below to complete your MEF (process will take approximately 10 minutes):

Use your Cornell Net ID and password to sign into myGannett (myGannett can also be found by clicking on the blue myGannett box located toward the upper right of your screen).

1. After you sign in, enter your birth date to confirm your identity.
2. From the Home screen, click on "Appointments" listed on the left side menu.
3. From the Appointments screen, click on "Complete Questionnaire" under "Currently scheduled appointments." The MEF will then appear on your screen.
   
4. Complete the MEF in full. Note that items marked with ** are required.
   
5. Click "Submit" when you are finished.
6. If you have answered all required questions, an immediate acknowledgement of successful submission will appear on the screen (you may now skip to step 8).
   
7. If you do not see an immediate acknowledgement, your form will reappear with the unanswered required questions highlighted in red. Complete all highlighted questions and resubmit the form.
   
8. Log out by exiting or quitting your browser.

An Occupational Medicine staff member will contact you if there is a need for further information or a medical appointment.

*Note that all information entered in myGannett is personal health information and therefore protected by HIPAA regulations. 

For PDF version of the MEF or for individuals without a Cornell Net ID

1. Print, complete, and sign the AUHSP Medical Evaluation Form (pdf).
2. Send the completed form to:
   

Occupational Medicine
Cornell University
110 Ho Plaza
Ithaca NY 14853-3101.

A staff member will contact you if there is a need for further information or a medical appointment.

Contacts

If you need assistance or have questions regarding the MEF process, contact Occupational Medicine via email or by phone at 607 255-6960.

For general questions about AUHSP, contact auhsp@cornell.edu.

Additional Resources

Environmental Health and Safety
Cornell Center for Animal Resources and Education (CARE)
Animal Users Health and Safety Program (AUHSP)
Institutional Animal Care and Use Committee